Trigger points in the quadriceps muscles are commonly the cause of hip, thigh and knee pain

The quadriceps is a large group of muscles, the most massive of the leg, located in the anterior (front) of the thigh. They originate from above the hip joint and extend to below the knee.

The primary action of the quadriceps is to extend the knee joint, but in conjunction with a number of other muscles in the front of the hip, they are also associated with hip flexion.

Rectus femoris is part of the quadriceps femoris, which also includes the vasti group: vastus lateralis, vastus medialis, and vastus intermedius. It has two heads of origin.

The reflected head is in the line of pull of the muscle in four-footed animals, whereas the straight head seems to have developed in humans as a result of the upright posture. It is a spindle-shaped bi-pennate muscle.

The quadriceps straighten the knee when rising from sitting, during walking, and climbing. The vasti muscles cross only the knee, and thus are limited to knee extension or resistance to knee flexion; they spread out to control the movement of sitting down.

Vastus medialis is larger and heavier than vastus lateralis. Vastus intermedius is the deepest part of the quadriceps femoris, and has a membranous tendon on its anterior surface to allow a gliding movement between itself and the rectus femoris that overlies it.

The quadriceps tendon attaches to, and covers the patella, becoming the patellar tendon below this and attaching to the tibia.

Included here is sartorius, not part of the quadriceps femoris group, but the most superficial muscle of the anterior thigh; it is also the longest strap muscle in the body.

The medial border of the upper third of this muscle forms the lateral boundary of the femoral triangle (adductor longus forms the medial boundary; the inguinal ligament forms the superior boundary). The action of sartorius is to put the lower limbs in the cross-legged seated position of the tailor (hence its name from the Latin).

Quadriceps and Trigger Points

Trigger points in the quadriceps are commonly responsible for painful hip, thigh and knee conditions.

Note that Trigger points in the rectus femoris can often cause deep aching pain in the front of the knee, even though the trigger points themselves are typically found closer to the hip.

Whilst there is no substitute for hands-on treatment from a trigger point professional, stretching exercises can be very useful both to help avoid these trigger points becoming active (injury prevention) and for rehabilitation.

Below you will find details of 5 awesome stretching exercises that most people should be able to perform easily at home. These are typical of exercises that your trigger point therapist might recommend.

1. Single leg stand stretch

Technique

Stand upright while balancing on one leg. Pull your other foot up behind your buttocks and keep your knees together while pushing your hips forward. Hold on to something for balance.

Note! This position can put undue pressure on the knee joint and ligaments. Anyone with knee pain or knee injury should avoid this stretch until they have sought advice from a suitably qualified healthcare practitioner.

Primary muscles

• Rectus femoris
• Vastus medialis, lateralis, and intermedius.

Secondary muscles

• Iliacus.
• Psoas major.

Injuries where this stretch may be useful

• Hip flexor strain
• Avulsion fracture in the pelvic area.
• Osteitis pubis. Iliopsoas tendonitis.
• Trochanteric bursitis.
• Quadriceps strain.
• Quadriceps tendonitis.
• Patellofemoral pain syndrome.
• Patellar tendonitis.
• Subluxing kneecap.

 2. Standing forward lunge

Technique

Stand upright and take one small step forward. Reach up with both hands, push your hips forward, lean back, and then lean away from your back leg.

Regulate the intensity of this stretch by pushing your hips forward.

Primary muscles

• Rectus femoris.
• Psoas major.
• Iliacus.
• Sartorius.

Secondary muscles

• Rectus abdominis.
• Transversus abdominis.
• External and internal obliques.
• Quadratus lumborum.

Injuries where this stretch may be useful

• Hip flexor strain.
• Avulsion fracture in the pelvic area.
• Osteitis pubis.
• Iliopsoas tendonitis.
• Trochanteric bursitis.
• Quadriceps strain.
• Quadriceps tendonitis.

 3. Reclining Single Leg Lean

Technique

Sit on the ground, bend one knee and place that foot next to your buttocks. Then slowly lean backwards.

Note! This position can put undue pressure on the knee joint and ligaments. Anyone with knee pain or knee injury should avoid this stretch until they have sought advice from a suitably qualified healthcare practitioner.

Primary muscles

• Rectus femoris.
• Vastus medialis, lateralis, and intermedius.

Secondary muscles

• Iliacus.
• Psoas major

Injuries where this stretch may be useful

• Hip flexor strain.
• Avulsion fracture in the pelvic area.
• Osteitis pubis.
• Iliopsoas tendonitis.
• Trochanteric bursitis.
• Quadriceps strain.
• Quadriceps tendonitis.
• Patellofemoral pain syndrome.
• Patellar tendonitis.
• Subluxing kneecap.

4. Reclining double leg lean

Technique

Sit on the ground and bend one or both knees and place your legs under your buttocks. Then slowly lean backwards.

Note! This position can put undue pressure on the knee joint and ligaments. Anyone with knee pain or knee injury should avoid this stretch until they have sought advice from a suitably qualified healthcare practitioner.

Primary muscles

• Rectus femoris.
• Vastus medialis, lateralis, and intermedius.

Secondary muscles

• Iliacus.
• Psoas major.

Injuries where this stretch may be useful

• Hip flexor strain.
• Avulsion fracture in the pelvic area.
• Osteitis pubis.
• Iliopsoas tendonitis.
• Trochanteric bursitis.
• Quadriceps strain.
• Quadriceps tendonitis.
• Patellofemoral pain syndrome.
• Patellar tendonitis.
• Subluxing kneecap.

5. Kneeling forward lunge

Technique

Kneel on one foot and the other knee. If needed, hold on to something to keep your balance. Push your hips forward.

Regulate the intensity of this stretch by pushing your hips forward. If need be, place a towel or mat under your knee for comfort.

Primary muscles

• Iliacus.
• Psoas major and minor.

Secondary muscles

• Rectus femoris.
• Sartorius.

Injuries where this stretch may be useful

• Hip flexor strain.
• Avulsion fracture in the pelvic area.
• Osteitis pubis.
• Iliopsoas tendonitis.
• Trochanteric bursitis.
• Quadriceps strain.
• Quadriceps tendonitis.

About the author

Stuart Hinds is one of Australia’s leading soft tissue therapists, with over 27 years of experience as a practitioner, working with elite sports athletes, supporting Olympic teams, educating and mentoring others as well as running a highly successful clinic in Geelong.

Stuart has a strong following of practitioners across Australia and globally who tap into his expertise as a soft-tissue specialist. He delivers a range of highly sought after seminars across Australia, supported by online videos, webinars and one-on-one mentoring to help support his colleagues to build successful businesses.

In 2016, Stuart was awarded a lifetime membership to Massage & Myotherapy Australia for his significant support and contribution to the industry.

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This trigger point therapy blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.